William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What are sexual problems in men?

Sexual health is an important part of a man's life, no matter his age, civil status, or sexual orientation. It is also an important part of a couple's foundation and contributes to the quality of life. Sexual problems in men are very common and impact sexual health. Many problems can be treated and therefore it is important for a man to discuss these issues with a physicians.

The definition of sexual dysfunction is the inability to have a satisfactory sexual relationship. This definition depends on each person's own interpretation on what he judges satisfactory. In general, sexual dysfunction can affect the quality of life and, even more importantly, can be the first symptom of another medical or psychological problem. Any sexual complaint should be taken seriously and evaluated.

What is the physiology of sexual function?

Sexual activity involves coordination between various systems of the body. Hormones and neurological pathways must be in sync for sexual desire to be present. Blood vessels, nerves, and penile integrity must all be present for an adequate erection and its maintenance during the sexual relation. Muscles and nerves coordinate ejaculation achieved when the physiological passageway for sperm (from the testicles to the urethra) is present. Orgasm is a complex phenomenon that isn't completely understood but it involves the coordination of muscles and nerves. When sexual dysfunction is present, the physician must evaluate all the possible problems in this chain of events.

How are sexual problems in men diagnosed?

Evaluation of sexual dysfunction starts with a detailed medical, sexual, and psychological history, followed by a thorough physical examination. The second step must not be overlooked because sexual dysfunction can have many causes. Sometimes, the patient's partner can also contribute to the evaluation and could provide useful information as well.

A detailed medical, psychological, and sexual history is acquired during the interview with the physician. Some of the questions that are asked can be intimate and might cause you to feel shy to answer thoroughly. It is imperative to give the proper information, even though it is understandable that it can take time to be comfortable talking about this. Having a good relationship with your physician is always helpful.

Some of the questions the doctor could ask might concern the frequency of sexual relations, your sexual orientation, if the frequency or quality of sexual relations are satisfying, and your number of sexual partners, among others. They will also inquire about nonsexual-related complaints.

A complete physical examination is performed including assessing the pulses in the legs and a thorough examination of the external genitalia (penis, scrotum, and perineum) and their reflexes..

One of the possible tests is a nocturnal tumescence test to evaluate nocturnal erections. Your physician might also ask for tests for penile blood vessel function or some tests of the nervous system to help differentiate between possible causes of sexual dysfunction.